Provider Demographics
NPI:1639460926
Name:GOOSBY, AYRIEKA
Entity Type:Individual
Prefix:
First Name:AYRIEKA
Middle Name:
Last Name:GOOSBY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6200 BAKERS FERRY RD SW
Mailing Address - Street 2:APT 702
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-8392
Mailing Address - Country:US
Mailing Address - Phone:678-536-7173
Mailing Address - Fax:
Practice Address - Street 1:6200 BAKERS FERRY RD SW
Practice Address - Street 2:APT 702
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-8392
Practice Address - Country:US
Practice Address - Phone:678-536-7173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-21
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program